Upheld, recommendations

Summary

Mr C said that during gale force winds the boundary wall between a council building and his home collapsed. The debris fell into his garden, damaging his property, and he made a compensation claim to the council. The company who handled this on the council's behalf turned the claim down, and Mr C complained to us that in doing so they followed an unreasonable process. He said that they did not consider all relevant evidence, failed to clearly and consistently explain the reasons for their decision and delayed unreasonably in processing his claim.

Although we found that the company's record-keeping was lacking at some points, we found no evidence that they failed to consider all the evidence required to process the claim. Neither did we find the timescales in processing his claim unreasonable, although they should have written with an update during the early stages. They responded to Mr C's remaining enquiries quite promptly.

The documentation confirmed, however, that the company changed the rationale behind their decision during the course of the correspondence. This would not have been unreasonable if new evidence had come to light. However, we could see no clear reason for the differing explanations. The company made no further enquiries and did not obtain new evidence after issuing their second decision letter, but continued with the change in their reasoning. They also failed to respond to one of Mr C's main arguments in support of his claim, although they had information about this from the council. There was no clear record of the company's actions in response to each of Mr C's communications, or of how this affected their decision-making.

We were also critical because the council did not deal with this under their complaints procedure. The determination of liability would be a matter for the courts. However, a complaint about the administrative handling of a claim falls within the remit of the council's complaints procedure and should have been dealt with through that. Overall, we upheld Mr C's complaint and made recommendations.

Recommendations

We recommended that the council:

• feed back our decision to the staff involved to ensure that such failings do not occur in future;
• ensure that the company record all key actions/communications on their handling of future claims; and
• provide Mr C with a written apology for the failings identified.

Summary

Mr C's elderly mother (Mrs A) suffers from vascular dementia (a common form of dementia, caused by problems in the supply of blood to the brain). Mrs A was in receipt of a meals service provided to her at home. The council had contracted with a company (the contractor) for the meals service, and the contractor had then sub-contracted this to a meals service provider (the provider). Mr C believed that his mother might have made unreceipted cash payments to the provider's delivery driver. Mr C complained that the council did not assess the risk of doorstep cash payments for users of the meals service.

Mr C said that both the council and the provider had refused to allow him to pay by direct debit, while allowing users of the service to pay by cash on the doorstep. He complained that the council had failed to reasonably assess the risks of doorstep payments, particularly in the case of elderly and vulnerable service users. He pointed out that without receipts it was not possible to verify what payments were made. The council said that all appropriate capability and risk assessments, including security checks, were carried out and that their actions in respect of Mrs A had complied with their equality duties. They said they had not refused to allow direct debit payments - rather the provider did not have the facility for this. Following their investigation of Mr C's complaint, they said that the delivery driver now gave the recipient of the service a written receipt for cash and cheque payments. In Mrs A's case, the council also agreed to meet the full cost of the meals service with the provider and then recharge Mrs A for this.

We were satisfied that it was a matter for the council, in consultation with the contractor and the provider, to create policies and procedures for the provision and operation of the service, including payment methods. However, we upheld Mr C's complaint as, although the council had carried out various assessments in respect of users of the service, we were not persuaded that these addressed the risk issues of cash payments, particularly for vulnerable service users such as Mrs A. We also considered that the system that was in place did not have sufficient safeguards to properly evidence what, if any, payment was made when the meal was delivered, and we made a recommendation about this. We saw no evidence that the council had previously refused to allow payment by direct debit, and accepted that the system in place at the time did not allow for this.

Recommendations

We recommended that the council:

• issue Mr C with an apology for the failings identified in this complaint; and
• discuss with the contractor and the provider obtaining a duplicate receipt for all cash and cheque payments.

Summary

The council put up a fence dividing the area that Mr C and his neighbours used as a driveway, causing them difficulty in accessing the area with vehicles. Mr C complained to the council about this and then, when he was dissatisfied with their responses, he complained to us.

We found inconsistencies in the council's responses, and that they did not respond at all to one of his letters, and so we upheld his complaint.

Recommendations

We recommended that the council:

• apologise to Mr C for their failure to reasonably respond to his complaints; and
• reconsider their response to Mr C's complaints and provide him with a clear and consistent response.

Summary

When Mr C moved into a new property, he discovered that the roof space was not adequately insulated. He contacted the developer and the council. Following discussion with the developer, he contacted the council's building standards department for help and asked for a copy of an updated drawing for the roof space. It took seven months for the council to provide the drawing. Mr C was then unhappy with the handling of his complaint about this, and that an email to the chief executive had not been responded to.

Having carefully considered his complaint and documentation, we considered that there was an unreasonable delay in providing Mr C with a copy of the drawing. The council had already agreed to apologise to Mr C for this. We also found that they had not made sure that Mr C was aware of their role and limitations in helping him try to resolve issues with the developer. We found that the complaints handling had been poor. The council had not followed their published complaints procedure on a number of occasions during the handling of his complaint, and had not considered whether the particular circumstances meant that they should have escalated it straight to the investigation stage of their procedure. The council acknowledged that Mr C's email to the chief executive was not responded to in a timely manner.

Recommendations

We recommended that the council:

• feed back to building standards staff that, should a similar situation occur again in future, they should take steps to ensure that members of the public are made aware of the council's role and limitations and manage expectations appropriately;
• in light of the failings identified by Mr C's complaint, undertake a full review into their handling of it to identify what practices, processes or procedures they can put in place to prevent similar failings happening again;
• apologise to Mr C for the failings identified in the handling of his complaint; and
• apologise to Mr C for the delay in responding to his email.

Summary

When Mr C's aunt moved into a nursing home, the council provided interim funding for her fees until they could complete the appropriate financial assessment. Once this was done, they tried to recover the cost from Mr C. He complained that there was confusion about how much was owed. The council investigated and upheld Mr C's complaint. They found three main errors. They had originally charged for an additional week's care, requiring the invoice to be amended; and the nursing home had charged the council at an outdated rate for part of this time and the invoice again had to be reissued. Finally, there was a numerical typing error in one of the council's letters which meant that the amount shown as the balance owed was wrong.

We noted the problems that they had found, and what they had done to address these. However, we also found another error in the correspondence. The council had written to Mr C's solicitor to explain that the weekly rate changed on 1 April 2013. They then wrote to him again less than two weeks later to say that the change took effect from 8 April 2013. Taking everything into account, we upheld Mr C's complaint. As, however, the council had provided documentary evidence to show what they had already done to prevent this from happening again, we made only one recommendation.

Recommendations

We recommended that the council:

• apologise to Mr C for the confusion in their handling of this matter.

Summary

Ms C said that she had a contraceptive implant fitted and when it was near the end of its life, she attended her GP for a replacement. She complained that she was told that because of her high blood pressure (BP) it was not possible to do so. As it appeared that Ms C was not taking her medication to reduce her BP, she was advised to do so and return to the practice in six to eight weeks time for review.

Ms C attended again to have her implant reinserted but again her BP was noted to be very high. She was told that if there was an attempt to replace it there was a risk of uncontrolled bleeding and it was agreed that she should attend a local hospital for replacement. Ms C felt that she had been given unreasonable care and treatment because the reason why she had an implant fitted in the first place was because of her BP. She complained that the GP's actions left her without effective contraception.

During our investigation, we took independent advice from one of our medical advisers, who is a GP. The adviser said that although the GP said she had acted in Ms C's best interests and followed national advice on implantable progesterone contraception like the type used by Ms C, she had in fact misunderstood the advice. In cases similar to Ms C's, the benefits of remaining on the contraceptive, despite her BP, would likely outweigh the risks as it was recognised as a safer option for women with high BP. In the circumstances, we considered it unreasonable that Ms C was left without an effective form of contraception for over seven weeks.

Recommendations

We recommended that the practice:

• ensure the GP apologises for the fact that Ms C was left for some time without contraception; and
• ensure the GP undergoes specific training with regard to the safety and contraindications of that particular contraceptive.

Summary

Mr C complained that the board failed to appropriately investigate the cause of his severe back pain following his admission to Perth Royal Infirmary. He said the board failed to carry out an MRI scan (used to diagnose health conditions that affect organs, tissue and bone) to allow an accurate diagnosis to be reached at an earlier date, and that he had to arrange for this to be done privately.

We obtained independent medical advice on Mr C's case from one of our medical advisers, a consultant in orthopaedic and trauma surgery. Our adviser explained that Mr C's clinical picture after he was admitted should have guided the board's management of his condition. He explained that this could only be properly ascertained after taking an adequate history and clinical investigations. It appeared that the consultant orthopaedic surgeon did not fully examine Mr C, and relied on a junior doctor's examination, but this was reasonable as long as the junior doctor's assessment was thorough. However, as the board were unable to provide a copy of Mr C's medical notes for his time in hospital, we could not say whether he was properly examined. On the MRI scan, our adviser said that Mr C was not displaying 'red flag' (warning sign) symptoms but that, in view of his condition, the benefits of arranging an MRI scan outweighed the risks. He said that an MRI scan could have been arranged either as an in-patient or after Mr C's discharge, but this did not happen.

Having considered the matter carefully, we were unable to say that Mr C's symptoms were appropriately investigated while he was in hospital to find the cause of his pain. If an MRI scan had been arranged when Mr C was an in-patient, he would not have had to arrange one himself, and if one had been arranged for him as an out-patient, then it was unlikely he would have arranged his own scan. We, therefore, considered it reasonable for the board to reimburse Mr C the cost of his private MRI. We were also very critical of their management of Mr C's medical records and that they were unable to provide us with these for his hospital stay.

Recommendations

We recommended that the board:

• feed back our decision on this case to the staff involved to ensure that a similar situation does not happen in future;
• reimburse Mr C the cost of his private MRI scan;
• review their practice on the storage of patients' medical records to prevent a recurrence of the failure to store Mr C’s medical records securely; and
• provide Mr C with a written apology for the failings identified.

Summary

Mr C's wife (Mrs C) had hip replacement surgery. She recovered well, but suffered constipation afterwards because of the painkilling medication she was prescribed. After having had no significant bowel movements for more than a week, Mrs C began vomiting and had a painful, hard stomach. Mr C phoned NHS 24 and asked for a home visit from a GP. Mrs C's case was prioritised as serious and urgent and Mr C was told that a district nurse would come within two hours. When the nurse did not arrive, Mr C called NHS 24 again. They investigated and learned that the district nurse would not visit new patients with constipation. Instead it had been arranged for a GP to call Mrs C for a further phone assessment.

Mr C was not happy with this, and was then told that NHS 24 would request an out-of-hours GP to visit within two hours. The out-of-hours GP was, however, required for another more serious call, and arrived about six hours after Mr C's initial call to NHS 24. He gave Mrs C two enemas and a prescription for laxatives. Mr C was advised to monitor his wife overnight and contact her own GP in the morning if she did not improve. As Mrs C did not improve, her own GP visited and immediately referred her to hospital, where she was diagnosed with a perforated bowel that needed emergency surgery. Mr C complained that NHS 24 did not prioritise Mrs C's case appropriately and that she could have been admitted to hospital more quickly had the out-of-hours GP attended sooner.

After taking independent advice on this case from one of our medical advisers, who is a GP, we upheld Mr C's complaint. We found that Mrs C's case was treated seriously and given the highest priority, but that NHS 24 should have requested a GP visit rather than a district nurse visit at the start. We were critical of NHS 24 for not gathering relevant information about Mrs C's bowel habits and pre-existing kidney failure, which would have helped staff decide the action to take.

We concluded that, although there was a clear delay in the out-of-hours GP attending, this was partly due to communication problems between NHS 24 and the local health board. NHS 24 and the board had already identified this and had taken action to improve communication. We were satisfied that, although his attendance was delayed, the out-of-hours GP's conclusions and treatment would not have been different had he visited Mrs C earlier. However, we recognised that she would have received the enemas and laxatives sooner and that this might have improved her chances of avoiding a perforated bowel, if it had not already occurred by then. We also recognised that the delays added to the discomfort and anxiety that Mrs C was experiencing.

Recommendations

We recommended that NHS 24:

• apologise to Mr and Mrs C for the issues highlighted in our investigation;
• remind their clinical staff of the importance of establishing each patient's level of renal failure and of taking this into account when progressing their treatment; and
• consider briefing their clinical staff on the need to consider whether patients have passed stools or gas in cases of severe constipation.

Summary

Mrs C went to her medical practice because she had been having headaches for a few months. She was given migraine medication to try, and an appointment was made for her to come back a week later. Mrs C did not go to the appointment but had called NHS 24, where the on-call doctor thought she might have acute sinusitis (inflammation causing facial pain). Later that month, Mrs C went back to the practice with her sister. She said the medication had not worked. She also had other problems, including being increasingly unable to socialise or attend to her personal hygiene. She was treated for sinusitis, but her symptoms became even worse, and she went back to the practice at the end of the month. She described increasing withdrawal, problems with her eyesight and that she had been off work for a number of weeks. The day after this appointment, NHS 24 were called again, and Mrs C was immediately admitted to hospital for a scan. She was diagnosed with a brain tumour and had an operation to remove it.

Mrs C complained that the GP at the practice failed to pick up on her serious illness and refer her to hospital. She said that as a consequence her life had been put at risk.

We obtained all the complaints correspondence and Mrs C's relevant clinical records and took independent advice from one of our medical advisers, who is a GP. Our investigation found that the GP missed a number of classic features associated with brain tumours. The adviser said that on her second visit to the practice Mrs C was demonstrating enough of these to merit urgent referral. He said that although some of the changes could be interpreted as being associated with depression, in his opinion that would be a secondary consideration in a patient with persistent headache and such a significant change in personality. The symptoms should have alerted the GP to a possible serious diagnosis and she should have made a comprehensive assessment including a detailed clinical examination, then referred Mrs C urgently if she felt that any element was beyond her clinical competence. We made recommendations, noting that the GP had already acknowledged that she had missed an important diagnosis and apologised for this, and that the practice had carried out a significant event analysis.

Recommendations

We recommended that the practice:

• formally apologise to Mrs C for a failure to properly examine her and then refer her on;
• confirm the actions taken to amend their procedures; and
• provide evidence that the matter has been addressed at the GP's next appraisal.

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mrs A), who had injured her knee in a heavy fall whilst on holiday. She was taken to a local hospital, where the injury was treated as a sprain. She then returned home and went to the accident and emergency department of Wishaw General Hospital next day. Mrs A was assessed, but the swelling around her knee made a full examination impossible. Mrs A was reviewed there again five days later, and damage to her ligaments was suspected. She was referred to the orthopaedic (dealing with conditions involving the musculoskeletal system) fracture clinic for further assessment.

Mrs A was seen by an orthopaedic consultant, who considered it likely that she had a fracture of her knee cap, so the leg was put in plaster. Mrs A said that she repeatedly returned to the hospital, as the cast was causing her severe discomfort. She also said she repeatedly informed medical staff that her knee felt unstable and 'caved in'. Although Mrs A was first seen in July 2012 it was not until November 2012, when she started physiotherapy, that she was diagnosed with several torn knee ligaments, requiring surgical repair.

Mrs C complained to us that Mrs A’s knee was never properly examined and staff ignored her (Mrs A’s) concerns. She also said Mrs A had suffered needlessly due to the delay in diagnosing her injury and had lost income as she had to take time off work.

We took independent advice from an expert in orthopaedic and trauma surgery. He said that it was normal to wait until the swelling had gone down before attempting to examine a badly injured knee joint. He said, however, that the record of Mrs A's treatment was inadequate and there was no evidence that her knee was properly examined. Our investigation found that while the initial treatment Mrs A had received was reasonable, overall her care and treatment was not of an acceptable standard. We found that although this did not ultimately affect the outcome of her surgery, she had suffered pain and discomfort due to an avoidable delay in diagnosing her injury.

Recommendations

We recommended that the board:

• remind orthopaedic staff of the importance of a thorough, documented examination of an injury as clinically appropriate;
• apologise for the failings identified in our investigation; and
• remind staff of the importance of clear and detailed clinical record-keeping.